Hemostasis disorders in intensive care unit in Assiut University Hospital: a prospective study

Abstract

Abstracts Hemostasis disorders either bleeding or thrombosis that occur in intensive care unit (ICU) are common multifactorial problems that affect morbidity and mortality. Prompt identification and correct management improve ICU patient’s outcome. The aim of this study is to assess the incidence of hemostasis disorders among ICU patients and to establish a relationship between hemostasis disorders and outcome of ICU patients. A total of 350 patients were admitted to ICU during the study period. Hundred were excluded secondary to having one or more exclusion criterion; liver diseases (n=33), receiving anticoagulant agents (n=23), bleeding or coagulation disorders at time of admission (n=17), atrial fibrillation (n=12), nephrotic syndrome (n=8), inherited coagulation defects (n=7) and 10 patients were excluded due to incomplete data. A total of 240 patients were recruited in the study analysis. Eighty (33.3%) patients developed different form of hemostatic disorders during their hospital stay within ICU while 160 (66.7%) patients did not develop hemostatic disorders. On admission patients with hemostasis disorder had significantly longer INR (1.10 ± 0.19 vs. 1.05 ± 0.09, P=0.03) and D-dimer (2.32 ± 0.97 vs. 0.55 ± 0.28, P<0.001) with lower fibrinogen level (77.56 ± 9.89 vs. 134.56 ± 10.98, P<0.001). The most frequent form of hemostasis was thrombocytopenia (55%) with mean platelets count (90.87 ± 10.19 × 109/l) followed by pulmonary embolism (16.2%) and DIC (13.7%) with mean D-dimer (2.87 ± 1.11). There were another three patients were found to had thrombasthenia. Four patients developed DVT, three patients were diagnosed as Churg-Strauss syndrome, and two patients had acute limb ischemia. Causes of thrombocytopenia were HIT (4.5%), sepsis (70.5%) and drug-induced (25%). Patients with hemostasis disorders had significantly longer hospital stay (13.12 ± 5.76 vs. 7.01 ± 1.43 (days); P<0.001) while patients without hemostasis disorders had significantly higher overall survival (19.25 (16.69–21.82) vs. 8.55 (8.11–8.98) days; P<0.001) in comparison to those with hemostasis disorders.,In Conclusion, critically ill patients are vulnerable to develop different forms of hemostatic disorders that may seriously affect the outcome. ClinicalTrials.gov Identifier: NCT04179357